Showing posts with label care. Show all posts
Showing posts with label care. Show all posts
Building A Care Management Program
Sunday, May 4, 2014
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| Care management planning |
But, say the Hardball-inspired Disease Management Care Blog readers, "tell us something we dont already know."
The DMCB found three useful nuggets of information:
1. There is no firm rule on the operational balance between central administration and peripheral distribution. Some of the Plans hire and oversee the care management nurses while others pay their network primary care sites to hire their own nurses. If the practices employ the nurses, they are free to let the managers see patients on an all-payer basis.
2. Care management caseloads vary from 35 to 150 persons and the enrollee to nurse ratio ranges from one full time nurse to 5000 to 14,000 commercial members. If less than 5000 Plan members are assigned to a primary care site, care managers split their time among multiple sites. As Plan members are further diluted or distributed through a network, there is greater reliance on remote telephonic communication and coaching.
3. Reduced costs? Group Health, Fallon and Security Health plan say they saved over $2.5 million, $2.3 million, and $1 million, respectively. Tufts Health Plan says they saved $1.90 for every dollar spent.
Other points known but worth repeating:
Features of successful care management include appropriate patient selection, person-to-person outreach, credentialed professionals, teaming, coaching on self-management, family involvement and access to community-based programs.
Embedding care managers in the primary care sites is worthwhile not only because face-to-face patient care has more of an impact, but because the physicians will benefit from the consultations, participation in "huddles" and discussion of the treatment plans. That also leads to a greater level of trust between the docs and the nurses.
Theres better buy-in if the care managers are viewed by enrollees as an extension of the physicians, not the sponsoring insurers.
Technology is important: effective care managers are made more effective by electronic records, telemonitoring, decision support, work-flow aids and video/mobile communication.
The backbone of care management is made up of generalist nurses who are simultaneously comfortable with multiple conditions such as, for example COPD, mental illness and diabetes. That being said, there is a role for focused nurse support for patients with special needs, such as hospice, transplant or bariatric surgery.
An abundance of data support is only the beginning because the reports will need to be tailored to the physicians clinical needs and communication perences. They also have to be paired with regular meetings that promote best practices and solicit feedback.
When care management is first rolled out, physicians will first suspect this is another managed care ruse, assume its a fast track to prior authorization or try to "downjob" clinical duties to the nurses that are outside of their scope of practice. It will take many months and much collaboration to sort out turf issues, control, office space, and offering care management to some but not all patients.
The U S Health Care Debate in Five Bullet Points
Friday, March 14, 2014
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| "This message will self-destruct...." |
This, in a Nußschale, is what the DMCB intends to say, using approximately eighteen PowerPoint slides:
1. While rising health care costs, as a percentage of U.S. GDP, has always been a problem, rising health care costs as a percentage of U.S. debt is widely viewed as a highly significant threat. We mean it this time.
2. The conservative vs. liberal debate over how to reduce health care costs for the U.S. government is ultimately about transferring its insurance risk. The conservatives want to transfer risk to patients in the form of vouchers, while the liberals want to transfer risk to providers in the form of bundled payments and gain-sharing. The liberals, so far, are handily winning the debate.
3. Risk is only half the health orm story. The other half is quality. There is bipartisan consensus that a) U.S. health care quality could be better, and b) greater quality will mitigate insurance risk, resulting in fewer medical complications, emergency room visits and readmissions.
4. There is additional bipartisan consensus that a) insurance risk can be managed and b) quality can be increased when care is provided in large vertically integrated and regional provider systems.
5. If the twin exigencies of risk and quality are not addressed in the next 3-5 years, disappointment could lead to the unraveling of Obamacare and the introduction of a public payer option.
Image from Wikipedia
Veggie Might How to Care for Cast Iron Cookware
Sunday, March 9, 2014
Penned by the effervescent Leigh, Veggie Might is a weekly Thursday column about the wide world of Vegetarianism.
Yesterday, Kris floored us with her Top 10 Kitchen Items list. So much good stuff—I use 6 of the 10 (pepper grinder, kitchen scale, food processor, bulk storage containers, tongs, and slow cooker) weekly, if not daily.
My choice of skillet, however, is cast iron all the way, and if I keep treating them properly, the two I have will be my nonstick pan of choice forever and ever, amen.Growing up Southern, every kitchen I knew had a cast iron skillet for frying chicken and baking cornbread. It’s a versatile piece of cookware, which makes it great for tiny New York apartment. Once I started cooking again, after a long hiatus of take-out and junk food, the cast iron skillet was my first purchase.
Seasoning a Cast Iron Pan
If you’re starting out with a new cast iron pan, you’ll need to “season” it. Seasoning is essentially baking on a layer of oil to fill in any nicks or divots in the surface of the pan and create a protective layer that prevents rust. Season your new pan, even if it is “pre-seasoned.” If you’re salvaging an antique, seasoning will restore the beauty to its former glory.
The InterWeb is rich with tips for seasoning your cast iron pan. My tried and true method is a combo of Grandma/Dad/Mom’s and a trick I picked up on What’sCookingAmerica.com.
1) Clean the pan with a mild soap and hot water. Use a fine-grade steel wool, salt, baking soda, or this handy potato method from TheKitchn to remove rust. (See below.) Rinse and dry completely.
2) Pre-heat the oven to 350°. Line the bottom of the oven with a baking sheet or foil.
3) Coat the entire pan, inside and out (Thanks, WCA!), with vegetable shortening (or any neutral cooking oil). Wipe off the excess.
4) Turn the pan upside-down and place it in the oven. Bake for 45 minutes.
5) Remove the pan from the oven and wipe off the excess oil. Give the cooking surface (and sides) another coat of shortening, wiping off any excess. Return to oven for another 30–60 minutes.
6) Turn off the oven, open the door, and allow to cool a bit before removing the pan.
7) Again, wipe off the excess oil. Your cast iron pan is ready to use.
Seasoning can be repeated anytime your pan is getting a little sticky or funky. Acidic foods, like tomatoes, break down the coating. Also, water is the enemy. Case in point:
Last week, I left my 5” cast iron skillet on the counter next to the sink for a couple of days. In that time, I washed a couple of sink-loads of dishes and made several pots of tea, which I spilled repeatedly. (I’m a klutz.)
When I went to use my little pan for a quick egg breakfast, the entire underside was covered in rust. I cut a potato in half, sprinkled a little baking soda on the rusty area, and gave it a scrub. Seriously, I don’t know what it is about the potato, but combined with baking soda, it only took about three passes (slicing off the used bits of potato each time) and 10 minutes for all the rust to disappear—even from those little grooves. (Tip: If you’re in the market for a cast iron pan, don’t get one with little grooves on the bottom.)
Even though the cooking surface looked okay, I re-seasoned the pan anyway (coating the inside AND outside). Now it’s back in action, and the outside is way more rust-resistant.
Cleaning and Maintaining a Cast Iron Pan
There is much debate over whether or not to use soap on a cast iron pan. It all depends on your comfort. I am squarely in the no-soap camp, but do what feels right for you. You just may need to re-season more frequently.
1) Clean your cast iron pan immediately after cooking. Letting food sit, particularly acidic foods, will break down the coating you’ve worked so hard to build.
2) Rinse with hot water and remove any debris with a natural fiber or plastic scrub brush. Do not use metal on cast iron—scrubbers or utensils. You can prevent metal on metal crime.
3) Dry immediately and thoroughly. Lingering water = rust. I usually put the pan back on the stove for a minute to cook off any renegade droplets.
4) Since it’s back on the stove, apply a thin, thin, thin layer of oil to the cooking surface. Heat for a few minutes; wipe off the excess; and store in a cool, dry place.
Cooking with Cast Iron
The more often you cook with your cast iron skillet, the more nonstick it will become. Eventually, you’ll only need a little bit of oil for even eggs to just slide right off the pan.
Plus, as I said before, cast iron cookware is versatile. It can go from the stovetop to the oven and handle both like a champ: sauté up a mess o’ greens and then bake a batch corn bread. You can pretty much do anything with a cast iron pan.
Cast iron cookware may seem like a lot of work, but the investment in time and care is worth the return you’ll get in durability, functionality, and longevity. This is cookware you can pass down through generations.
Can I get an Amen?
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If you liked this ditty, you may like
- 10 Essential Kitchen Items for the Healthy Cook
- Desert Island Gadgets
- HOW Old Is That Oatmeal? When to Clean Out the Pantry
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